Lemierre's Syndrome－抗生素時代後罕見之急性咽喉炎併發症－病例報告

Lemierre's Syndrome- Rare Complication of Acute Pharyngitis after Antibiotic Era-Case Report

胡志宇(Chih-Yu Hu) ； 呂俊廷(Chun-Ting Lu)

《台灣耳鼻喉頭頸外科雜誌》 55卷1期 (2020/03) Pp. 37-41

https://doi.org/10.6286/jtohns.202003_55(1).037

摘要

本篇個案報告討論1名60歲男性病患，上呼吸道感染1週後，以深頸部膿瘍為表現之Lemierre's syndrome。雖然此個案之血液細菌培養中無典型Fusobacterium Necrophorum，但病患之頸靜脈血栓及肺膿瘍之表現高度暗示Lemierre's syndrome之診斷。在抗生素發現及廣泛使用後，此診斷已不復常見，且其致死率也具變異性。因此，早期診斷及抗生素使用對此疾病之治療非常關鍵。此案例也強調在抗生素治療無效後，適時手術進行膿瘍引流，可避免併發症及降低致死率。我們也藉文獻回顧來探討抗凝血藥物在Lemierre's syndrome治療的適當性。

關鍵字

anticoagulant ； deep neck abscess ； jugular vein thrombosis ； Lemierre's syndrome（抗凝血藥物 ； 深頸部膿瘍 ； 頸靜脈血栓 ； 雷米爾氏症候群）

並列摘要

We describe a case of a 60-year-old male patient with Lemierre's syndrome who presented with a deep neck abscess following a 1-week history of upper respiratory tract infection. Although no typical presentation of Fusobacterium Necrophorumwas found in the blood culture, thrombus in the internal jugular vein and lung abscess were highly suggestive of the diagnosis. Because of its rarity in the post-antibiotic era and variability in mortality, early identification and antibiotic use are crucial. Lemierre's syndrome should be considered as a differential diagnosis when pharyngitis does not improve as expected and unilateral neck swelling develops. Our report emphasizes the importance of surgical drainage of the abscess despite antibiotic treatment to reduce the mortality of this disease. We also reviewed the literature to determine the appropriateness of anticoagulant use in the treatment of Lemierre's syndrome.

並列關鍵字

Anticoagulant ； Deep neck abscess ； Jugular vein thrombosis ； Lemierre's syndrome